Yonsei Med J.  2014 Nov;55(6):1556-1561. 10.3349/ymj.2014.55.6.1556.

Psychological Problems and Clinical Outcomes of Children with Psychogenic Non-Epileptic Seizures

• Yi YY
• Kim HD
• Lee JS
• Cheon KA
• Kang HC

• KMID: 2070202
• DOI: http://doi.org/10.3349/ymj.2014.55.6.1556

Abstract

PURPOSE
Our purpose was to investigate psychological problems and clinical outcomes in children with psychogenic non-epileptic seizures (PNES).
MATERIALS AND METHODS
We retrospectively reviewed the data of 25 patients who were diagnosed with PNES between 2006 and 2012.
RESULTS
Twenty-five children with PNES, aged 8 to 19 years (mean 13.82), were referred to psychiatrists for psychiatric assessment. On their initial visit, 72% of patients had comorbid psychological problems, including depression, anxiety, conduct disorder, adjustment disorder, Attention Deficit Hyperactivity Disorder, schizophrenia, and bipolar disorder. Among these, depression was the most frequent (36%). Predisposing and triggering factors included familial distress (40%), social distress (24%), and specific events (20%). The following treatment was advised based on the results of the initial psychological assessment: 3 patients regularly visited psychiatric clinic to assess their clinical status without treatment, nine underwent psychotherapy, and 13 received a combination of psychotherapy and psychopharmacological therapy. At the mean follow-up of 31.5 months after diagnosis, 20 patients (80%) were event-free at follow-up, three (12%) showed reduced frequency, and two (8%) experienced persistent symptoms.
CONCLUSION
The outcomes of PNES in children are much better than those in adults, despite a high rate of psychological comorbidities.

Keyword

Seizure; children; psychological

MeSH Terms

Adolescent
Adult
Anxiety/epidemiology
Attention Deficit Disorder with Hyperactivity/epidemiology
Child
Child, Preschool
Comorbidity
Depression/epidemiology
Depressive Disorder/epidemiology/psychology
Electroencephalography
Female
Humans
Male
Mental Disorders/*diagnosis/epidemiology/*psychology
Middle Aged
Psychophysiologic Disorders/*diagnosis/*psychology
Psychotherapy
Retrospective Studies
Seizures/diagnosis/*psychology/*therapy
Treatment Outcome
Young Adult

Reference

1. Szabó L, Siegler Z, Zubek L, Liptai Z, Körhegyi I, Bánsági B, et al. A detailed semiologic analysis of childhood psychogenic nonepileptic seizures. Epilepsia. 2012; 53:565–570.

2. Szaflarski JP, Ficker DM, Cahill WT, Privitera MD. Four-year incidence of psychogenic nonepileptic seizures in adults in hamilton county, OH. Neurology. 2000; 55:1561–1563.

3. Benbadis SR, Allen Hauser W. An estimate of the prevalence of psychogenic non-epileptic seizures. Seizure. 2000; 9:280–281.

4. Shen W, Bowman ES, Markand ON. Presenting the diagnosis of pseudoseizure. Neurology. 1990; 40:756–759.

5. Lancman ME, Asconapé JJ, Graves S, Gibson PA. Psychogenic seizures in children: long-term analysis of 43 cases. J Child Neurol. 1994; 9:404–407.

6. Finlayson RE, Lucas AR. Pseudoepileptic seizures in children and adolescents. Mayo Clin Proc. 1979; 54:83–87.

7. Silva W, Giagante B, Saizar R, D'Alessio L, Oddo S, Consalvo D, et al. Clinical features and prognosis of nonepileptic seizures in a developing country. Epilepsia. 2001; 42:398–401.

8. Bodde NM, Brooks JL, Baker GA, Boon PA, Hendriksen JG, Aldenkamp AP. Psychogenic non-epileptic seizures--diagnostic issues: a critical review. Clin Neurol Neurosurg. 2009; 111:1–9.

9. Lempert T, Schmidt D. Natural history and outcome of psychogenic seizures: a clinical study in 50 patients. J Neurol. 1990; 237:35–38.

10. Reuber M, Howlett S, Khan A, Grünewald RA. Non-epileptic seizures and other functional neurological symptoms: predisposing, precipitating, and perpetuating factors. Psychosomatics. 2007; 48:230–238.

11. Kanner AM, Parra J, Frey M, Stebbins G, Pierre-Louis S, Iriarte J. Psychiatric and neurologic predictors of psychogenic pseudoseizure outcome. Neurology. 1999; 53:933–938.

12. Ettinger AB, Devinsky O, Weisbrot DM, Ramakrishna RK, Goyal A. A comprehensive profile of clinical, psychiatric, and psychosocial characteristics of patients with psychogenic nonepileptic seizures. Epilepsia. 1999; 40:1292–1298.

13. Wyllie E, Friedman D, Rothner AD, Luders H, Dinner D, Morris H 3rd, et al. Psychogenic seizures in children and adolescents: outcome after diagnosis by ictal video and electroencephalographic recording. Pediatrics. 1990; 85:480–484.

14. LaFrance WC Jr, Keitner GI, Papandonatos GD, Blum AS, Machan JT, Ryan CE, et al. Pilot pharmacologic randomized controlled trial for psychogenic nonepileptic seizures. Neurology. 2010; 75:1166–1173.

15. Vincentiis S, Valente KD, Thomé-Souza S, Kuczinsky E, Fiore LA, Negrão N. Risk factors for psychogenic nonepileptic seizures in children and adolescents with epilepsy. Epilepsy Behav. 2006; 8:294–298.

16. Wyllie E, Glazer JP, Benbadis S, Kotagal P, Wolgamuth B. Psychiatric features of children and adolescents with pseudoseizures. Arch Pediatr Adolesc Med. 1999; 153:244–248.

17. Baslet G. Psychogenic nonepileptic seizures: a treatment review. What have we learned since the beginning of the millennium? Neuropsychiatr Dis Treat. 2012; 8:585–598.